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Feb. 9, 2000 (Rockville, Md.) -- The first director of the NIH's National Center for Complementary and Alternative Medicine is talking up the need for tougher science in the field. In his inaugural address to the center's public advisory council, half of whom practice alternative medicine, Stephen Straus, MD, emphasized that he wants solid scientific evidence on non-mainstream practices.
"The public deserves very definitive guidance as to which practices are safe and effective," Straus said. Since many published studies on complementary and alternative therapies are anecdotal or biased case reviews, he said, "Much of the literature gives a distorted view."
Recent surveys show that more than 40% of Americans tried alternative treatments in a one-year period, even though proof of their worth is scant. Lamar McGinnis, MD, a senior medical consultant for the American Cancer Society, tells WebMD, "There is very limited, if any, evidence related to the alternative therapies at this point."
According to Straus, large, randomized clinical trials are crucial in establishing the value of alternative treatments. Most of the center's budget goes towards clinical research on alternative treatments. Although practitioner-to-practitioner variability and nonstandardized materials may make designing studies difficult, he said, "lowering the bar" is not tolerable.
Acting NIH Director Ruth Kirschstein, MD, praised Straus' skill in conducting clinical trials.
At the same time, Straus has little experience practicing alternative medicine, which raises the eyebrows of some advocates. "That's a concern for a lot of people," congressional aide Beth Clay tells WebMD. A staffer to House Government Reform and Oversight Chairman Dan Burton, R-Ind., she says, "Can you imagine someone managing the National Eye Institute who wasn't an expert in eye disorders?"
Others are uncomfortable with the classic scientific approach that Straus espouses. Noting that "NIH represents the institutions of conventional medicine," council member Susan Holloran expressed concern over "taking pieces out of modalities," such as the center's evaluation of acupuncture removed from its role within Chinese medicine.
Straus responds, "We have no responsibility for cultivating a discipline."
James Gordon, MD, a professor at Georgetown University Medical Center in Washington, D.C., and director of the Center for Mind-Body Medicine, tells WebMD, "The center needs to focus not just on single therapies but also on integrative approaches." He concedes that "that's not part of a standard NIH model," but says, "A gold standard is appropriate for gold, but may not be appropriate for silver. There are other ways to evaluate therapies."
The center this year plans to spend 4% of its budget -- almost $3.5 million -- on training grants and fellowships for future researchers in the field.
The center started humbly in 1992 with a $2 million budget and no independent granting authority. By last year, lawmakers had upped its budget to more than $68 million for the current year.
Currently, the center has five large clinical trials underway, including an assessment of shark cartilage for lung cancer, and Straus unveiled plans for new studies. The center's plans for clinical research include evaluating milk thistle for liver diseases, melatonin and valerian for insomnia, feverfew for migraine headaches, and echinacea for upper respiratory tract infections and otitis media.
The center also is funding a controversial pancreatic cancer treatment regimen developed by Nicholas Gonzalez, MD, a Manhattan cancer specialist. The strategy, which involves coffee enemas and enzymes, has been criticized by several in the health care arena.
In her remarks to the center's council, Kirschstein emphasized that NIH has been a fortunate agency in recent years. "Congress and the administration have treated us very well," she said. "There is enormous trust and good faith there. ... We must assure that we have our priorities right."